不同腺苷预处理方法在心内直视手术中心肌保护效果对比.docVIP

不同腺苷预处理方法在心内直视手术中心肌保护效果对比 　【摘要】 目的 比较心内直视手术中应用不同的腺苷预处理方法的心肌保护效果。方法 将行心内直视手术非紫绀型先天性心脏病及瓣膜病患者60例，按术中应用腺苷预处理的方法的不同随机分为四组（每组15例）。A组：静脉腺苷组；B组：停跳液腺苷组；C组：静脉腺苷+停跳液腺苷组；D组：空白对照组。各组其他处理相同。分别于阻断升主动脉前、阻断升主动脉30 min、开放升主动脉15 min及术后24 h检测血清心肌肌钙蛋白T(cTnT)和丙二醛（MDA）水平。结果 各组血清cTnT、MDA均有明显升高，A组、B组和C组术中、术后血清cTnT、MDA水平均明显低于D组（P＜0.05）。B组与C组cTnT水平在术后24 h有显著性差异（P＜0.05）。结论 腺苷能模拟缺血预处理(IPC) 的心肌保护效应，并且各种处理方法均对缺血心肌有保护作用。在心内直视手术中可以根据客观条件灵活实施不同的腺苷处理方法。 【关键词】 腺苷 心内直视手术 腺苷预处理 心肌保护 Abstract: OBJECTIVE To compare the myocardial protective effects of adenosine preconditioning in patients undergoing intracardial surgery under extracorporeal circulation （ECC）. METHODS Sixty patients with non- cyanotic congenital heart disease or rheumatic heart disease were randomly divided into four groups (n=15 in each group). Group A: adenosine was intravenously injected from jugular vein. Group B: adenosine was put in St.Thomas cardioplegic solution. Group C: adenosine was infused from jugular vein and put in cardioplegic solution. Group D: control group. Other experimental conditions were the same. The level of plasma cardiac troponin T (cTnT) and malondialdehyde (MDA) were measured in each group respectively before ECC，30 minutes after the aorta clamping，15 minutes after the aorta declamping and 24 hours after the operation. RESULTS The level of plasma cTnT and MDA increased significantly in all groups, however, it was notably lower in group A, group B and group C than which in group D （P＜0.05）. At the stage 24h after operation, the expression of plasma cTnT in group B was significantly lower than that in group C (P＜0.05）. CONCLUSION Adenosine precondition can imitate the effect of myocardial preservation like ischemic precondition in patients undergoing open cardiac operation under ECC. All adenosine precondition methods used here can protect myocardium from myocardial ischemic- reperfusion injure. So we can select the method flexibly which is the best for cases. Key words： Adenosine;Open heart operation;Adenosin